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En un cauce natural o artificial es usual la presencia de vegetación en el fondo y en la pared. Los efectos que produce la presencia de ésta es una alteración en el campo de flujo. La magnitud de las alteraciones en el campo del flujo depende de la extensión, altura, densidad y flexibilidad de la vegetación. Para analizar a detalle las estructuras turbulentas, en este trabajo se realizó un estudio experimental en laboratorio en un canal de sección rectangular con un tramo de vegetación sumergida, flexible y artificial. La región de medición se ubicó aguas arriba de la zona de vegetación hasta el final de esta misma, además se determinó la asimetría que puede inducir la presencia de la pared del canal. Las mediciones se realizaron con equipo de velocimetría acústica de efecto Doppler (ADV). Los resultados obtenidos identifican el desarrollo de la capa de mezcla a partir de los patrones de velocidad media y los esfuerzos de Reynolds. En el caso de los perfiles de velocidad media sobre la capa de vegetación fue posible identificar un punto de inflexión donde se identificaron inestabilidades tipo Kelvin-Helmholtz. Con el fin de analizar los procesos en la capa de mezcla se propone un modelo fenomenológico basado en el análisis de la curvatura de las velocidades promediadas. Además, se determinó la aportación en el transporte de momento de las estructuras turbulentas con un análisis de cuadrantes con las velocidades fluctuantes.

Introduction: Autosomal Dominant Polycystic Kidney Disease(ADPKD) is a genetic disorder characterized by development of multiple renal cysts. Significantly enlarged cysts can encroach on anatomical space required for future renal transplantation and frequently cause recurrent infective and haematuria episodes throughout the patient's lifetime. This presentation aims to present the step-by-step surgical technique of modified supine hand assisted laparoscopic (HAL) bilateral nephrectomy for ADPKD in our series of 8 consecutive patients, as well as its advantages. Materials: From May 2016 to October 2020, a total of 8 patients who underwent HAL bilateral nephrectomy for ADPKD, by a single surgeon, was retrospectively evaluated in this study. A step-by-step HAL bilateral nephrectomy technique is as follows: (1) Modified supine positioning, (2) Midline GelPort® (Applied Medical) creation, (3) 10 × 12 mm upper midline and lumbar ports insertion for camera and working instruments, (4) Nephrectomy, (5) Operating team and equipment re-positioning, (6) Contralateral nephrectomy. The specimen can be extracted via the same incision for the hand-port, facilitating quick recovery with minimal post-operative pain and excellent cosmesis. Patient demographics, peri‐ and postoperative short-term outcomes were analysed. Results: 8 HAL bilateral nephrectomies were performed. Median operative time was 250 mins (IQR 182-230). Mean length of stay was 4 days (s=1.2 days) with a median blood loss of 200 millilitres (IQR 50 – 250 millilitres). Mean VAS analogue score on post-operative day 1 (POD) was 2.8 (s=1.4). The mean combined weight on histology was 3167g (s=1179g). Adrenal glands were preserved in all patients. There were no open conversions, no vascular or bowel injuries, with no grade 3 and above modified Clavien-Dindo classification complications. Conclusions: HAL bilateral nephrectomy for ADPKD is a safe and feasible technique which provides good postoperative outcomes with limited risk of complications while ensuring cosmetic satisfaction.

Objective: To evaluate the efficacy of multiparametric magnetic resonance imaging (mp-MRI) using Prostate Imaging Reporting and Data System version 2.0 (PI-RADSv2) definitions in detecting organ-confined prostate cancer. Methods: All patients who underwent radical prostatectomy between January 1, 2014 and December 30, 2014 were identified. All underwent mp-MRI within 180 days before surgery. Those with prior pelvic irradiation or androgen deprivation therapy were excluded. Fully embedded, whole-mount histopathology was centrally reviewed and correlated with imaging for tumour location, Gleason score (GS) and stage. Results: There were 39 patients included, of which 35 (90%) had mp-MRI done post-biopsy. A total of 93 cancer foci were identified on whole-mount pathology, of which mp-MRI detected 63 (68%). Of those detected by mp-MRI, 14 were PI-RADS 3 (n = 6 for GS 6, n = 8 for GS 7, no GS ≥ 8) and 49 were PI-RADS 4–5 (n = 7 for GS 6, n = 33 for GS 7, and n = 9 for GS ≥ 8). There were 30 (32%) cancer foci missed by mp-MRI (n = 15 for GS 6, n = 13 for GS 7 and n = 2 for GS ≥ 8). A lesion classified as PI-RADS 4–5 predicted a higher grade cancer on pathology as compared to PI-RADS 3 (for GS 7 lesions, odds ratio [OR] = 3.53, 95% CI: 0.93–13.45, p = 0.064). The mp-MRI size detection limit was 20 mm2 and 100 mm2 for 50% and 75% probability of cancer, respectively. In associating with radiological and pathologic stage, the weighted Kappa value was 0.69 (p

Severe retroperitoneal haemorrhage after retrograde pyelogram (RPG) is rare and has not been reported in the literature. One of the few indications for performing RPG in end-stage kidneys is evaluation of the upper urinary tract for malignancy. We present a rare case of massive retroperitoneal haemorrhage in a 58-year-old man, with a history of deceased donor kidney transplantation for end-stage kidney disease (ESKD), following bilateral RPG for the evaluation of urothelial cancer. The bleeding was successfully stopped with renal artery angioembolisation. This case demonstrates the importance of exercising extra caution when performing endoscopic procedures in patients with ESKD and keeping the intrarenal pressure as low as possible.

Background: Laparoscopic living-donor nephrectomy is the current epitome of living kidney donation surgery. We review our experience in living-donor nephrectomies over the last 19 years, transitioning from open surgery to hand-assisted laparoscopy to full laparoscopic techniques. Methods: We retrospectively identified all living-donor nephrectomies performed at our institution from 1976 to 2018. The donors were categorised according to surgical techniques: open (ODN), hand-assisted laparoscopy (HALDN) and full laparoscopy (LDN). We reviewed changes in donor demographics over the years. Surgical outcomes between groups were compared from 2000 to 2018. We also compared the outcomes of LDN between different time periods to evaluate our learning curve. Results: A total of 214 living-donor nephrectomies were performed between 2000 and 2018. The majority were left sided (93%) and had single renal artery anatomy (90%). There were 22 ODN, 20 HALDN and 163 LDN cases. The mean operating time was 84±43, 151±32 and 179±37 minutes for ODN, HALDN and LDN, respectively ( p

Introduction and objectives: The rate of symptomatic lymphoceles requiring intervention after renal transplantation is reported to be only 5.6%. Controversies prevail in the current literature regarding the management of symptomatic lymphoceles post renal transplantation, with no established algorithm. The creation of a peritoneal window, frequently performed laparoscopically, is deemed the gold standard for management. We herin report the case of a lymphocele post renal transplant treated minimally invasively with intranodal lymphangio-embolisation, with a review of the current literature of this uncommon procedure. Methods: This was a retrospective review of this patient’s electronic medical records. Results: We present a 43-year-old male with end-stage kidney disease secondary to chronic glomerulonephritis, having been on hemodialysis for seven years. He underwent a deceased donor dual kidney transplant, complicated postoperatively by renal vein thrombosis in one of the grafts, resulting in early graft nephrectomy as well as a distal ureterovesical leak requiring reimplantation. On re-implantation on postoperative day 16, he was noted to have a persistent high drain ouput with a normal drain fluid creatinine. A right intranodal lymphagiogram was performed, and this demonstrated an active lymph leak around the transplanted kidney. A 33% glue (N-butyl cyanoacrylate)-Lipodiol infusion was then injected at a rate of 0.2 mL/min intranodally under fluoroscopic guidance. The patient underwent another repeat embolisation five days later for a residual lymph leak with satisfactory results. Drain output subsequently decreased, and the drain was removed. Conclusions: This case suggests that intranodal lymphangiography and embolisation may not only be a diagnostic tool but can be considered as an effective, minimally invasive and safe method for the treatment of lymphoceles after kidney transplantation.

The main objective of the present study was to evaluate the patterns of accidents at the land level in Ecuador during 2016. A positivist paradigm was used with a descriptive, correlational, expos-facto and transversal method, in which a total of 30269 records corresponding to the characteristics of traffic accidents. A documentary review was made of where the information was extracted. The records were supplied by the National Transit Agency (ANT). Descriptive statistics was used to characterize the problem situation and statistical independence tests Chi Square and Logistic Regression tests were applied. The variables considered in the study were: Province, Month, day, time of accident, type of accident, probable cause, area of occurrence, number of injuries and number of deaths. The result was: high percentage of accidents in Pichincha, Guayas and Imbabura, preponderant months January, December and October. Days and time of major accidents Friday from 19:00 to 19:59 and Saturdays from 20:00 to 20:59. Which are due to Driver's crashes and lack of skill, with a balance of less than 7 injured and less than 4 deaths. Statistical relationship between the variables is evidenced: class of accident and day, month and probable cause and cause of the accident and time, at a level of 5%. As for the logistic regression, the variables with the greatest statistical significance were: Time: 16:00 to 16:59 p.m. and 19:00 to 19:59. Causes: Drunkenness / Drugs and Excess Speed; Class: Run-ins, Starings, Friction and loss of track; Month: January and October; Day: there was no discrimination.

Testicular metastasis is rare with the prostate being the most common site of primary cancer. We report a case of a 72-year-old man with castration-resistant prostate cancer (CRPC) and known metastases to bone and lymph nodes, who developed bilateral painful swollen testes 3 years after the initial diagnosis of prostate cancer. He had first presented with lower urinary tract symptoms (LUTS) with suspicious findings on digital rectal examination of the prostate, and an elevated serum prostate specific antigen (PSA) level of 129 ng/mL. Transrectal prostate biopsy revealed Gleason 4 + 5 adenocarcinoma. Radiological staging showed locally advanced prostate cancer with extensive metastases to bone and pelvic and retroperitoneal lymph nodes. He was given hormonal therapy for over 2 years until progression to CRPC. Six months later he developed painful bilateral testicular swellings, and serum markers for testicular germ cell cancer were normal. Bilateral orchiectomy was performed, showing metastatic prostate cancer (Gleason 4 + 5) on histology. One month postoperatively his PSA level dropped to 0.1 ng/mL from a presurgery level of 6.24 ng/mL. Keywords: Castration-resistant prostate cancer, Metastases, Testicular tumor, Orchiectomy

Los términos conocimiento, tecnología e innovación cada vez más forman parte del vocabulario empresarial, al reconocerse como pilares para el éxito de cualquier organización en el siglo XXI. Especialmente en la prestación de servicios sociales como la salud pública la gestión de la innovación debe constituir una prioridad para la atención con calidad y efectividad de los acuciantes problemas de salud que afectan a la humanidad. El objetivo del artículo es analizar el desarrollo de la gestión de la innovación en los servicios de salud pública. El análisis bibliográfico realizado incluyó material de los últimos seis años en cuatro bases de datos regionales, acerca de la gestión de la innovación en servicios de salud pública. La investigación ha constituido una preocupación constante en los servicios de salud pública, lo que requiere de la gestión continua de la innovación en sus entidades, con énfasis en los aspectos que la literatura considera más relevantes, como el talento humano, la estrategia y cultura organizacional, la relación con los clientes y entidades colaboradoras en especial las educativas. La gestión de la innovación constituye una prioridad para las entidades de salud, en correspondencia con las políticas públicas que promueven la solución continua a los problemas poblacionales de salud.

Background. Near infrared light (NIR) fluorescence imaging with indocyanine green (ICG) has been used in various aspects of surgery, such as in the assessment of vascular anastomosis, tissue perfusion, and the identification of lymph nodes. In this study we evaluated the utility of NIR/ICG fluorescence imaging in kidney transplantation. Materials and Methods. NIR/ICG imaging was used to assess allograft perfusion in n=1 living donor (LDRT) and n=2 deceased donor (DDRT) renal transplantations, performed in February 2017. The allograft arterial and venous anastomoses were done end-to-side to the corresponding recipient external iliacs, and ureteroneocystostomies were performed for urinary reconstructions. After completion of vascular anastomosis, ICG was given as intravenous bolus at 0.3mg/kg, followed by visual assessment of tissue perfusion and vascular anastomoses at 1-minute interval using fluorescence imaging (KARL STORZ NIR/ICG System). Results. Homogenous global fluorescence of the allograft and vascular anastomosis was observed in all 3 cases. Immediate postoperative perfusion studies showed patent inflow and outflow vessels and well perfused transplanted kidneys. Immediate graft function was observed in 2 recipients (1 LDRT and 1 DDRT). One session of haemodialysis was performed in 1 DDRT recipient, for high serum potassium in the immediate postoperative setting, who otherwise had good urine output and serially declining serum creatinine. Conclusions. NIR/ICG fluorescence imaging can be useful in renal transplantation for the intraoperative assessment of allograft perfusion, especially in complex cases with multiple renal arteries and vascular reconstructions.

Background Groin dissections result in large wounds with exposed femoral vessels requiring soft tissue coverage, and the reconstructive options are diverse. In this study we reviewed our experience with the use of the pedicled anterolateral thigh and vertical rectus abdominis musculocutaneous flaps in the reconstruction of large groin wounds. Methods Groin reconstructions performed over a period of 10 years were evaluated, with a mean follow up of two years. We included all cases with large or complex (involving perineum) defects, which were reconstructed with the pedicled anterolateral thigh musculocutaneous or the vertical rectus abdominis musculocutaneous (VRAM) flaps. Smaller wounds which were covered with skin grafts, locally based flaps and pedicled muscle flaps were excluded. Results Twenty-three reconstructions were performed for large or complex groin defects, utilising the anterolateral thigh (n=10) and the vertical rectus abdominis (n=13) pedicled musculocutaneous flaps. Femoral vein reconstruction with a prosthetic graft was required in one patient, and a combination flap (VRAM and gracilis muscle flap) was performed in another. Satisfactory coverage was achieved in all cases without major complications. No free flaps were used in our series. Conclusions The anterolateral thigh and vertical rectus abdominis pedicled musculocutaneous flaps yielded consistent results with little morbidity in the reconstruction of large and complex groin defects. A combination of flaps can be used in cases requiring extensive cover.

Los términos conocimiento, tecnología e innovación cada vez más forman parte del vocabulario empresarial, al reconocerse como pilares para el éxito de cualquier organización en el siglo XXI. Especialmente en la prestación de servicios sociales como la salud pública la gestión de la innovación debe constituir una prioridad para la atención con calidad y efectividad de los acuciantes problemas de salud que afectan a la humanidad. El objetivo del artículo es analizar el desarrollo de la gestión de la innovación en los servicios de salud pública. El análisis bibliográfico realizado incluyó material de los últimos seis años en cuatro bases de datos regionales, acerca de la gestión de la innovación en servicios de salud pública. La investigación ha constituido una preocupación constante en los servicios de salud pública, lo que requiere de la gestión continua de la innovación en sus entidades, con énfasis en los aspectos que la literatura considera más relevantes, como el talento humano, la estrategia y cultura organizacional, la relación con los clientes y entidades colaboradoras, en especial, las educativas. La gestión de la innovación constituye una prioridad para las entidades de salud, en correspondencia con las políticas públicas que promueven la solución continua a los problemas poblacionales de salud.